on a 6-degree-of-freedom motion platform in virtual environments (VEs) for 9 training sessions over 3 weeks. Platform movements were computer controlled to ...
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Poster Session II
on gait speed when gait was evaluated in single-task condition (p < 0.001), independently of training condition, but only EG presented a significant improvement on gait speed in dual-task condition (p < 0.01). Further, there was a significant improvement on divided attention performance (p < 0.01). In conclusion, the gait training in dual-task condition improves the automatic control of gait and the ability to manage the attention between two tasks in PPD.
Conclusions: This study further supports the reported benefits of acoustic pacing in pathological gait. Although different pacing configurations did not markedly affect gait, perceptual-motor coupling deteriorated when patients were instructed to synchronize paretic footfalls to the metronome. Improved understanding of underlying perceptual-motor control principles may tentatively increase the efficacy of the use of acoustic pacing in gait training after stroke.
P2.089 Virtual reality (VR) training to promote anticipatory gait control post stroke
P2.091 Assessment of spatio-temporal gait parameters with an ambulatory gait monitor in patients with Parkinson’s disease A.D. Speelman° , M. van Nimwegen, B.R. Bloem, G.F. Borm, M. Munneke Nijmegen, The Netherlands
C.L. Richards1° , B.J. McFadyen1 , F. Malouin1 , F. Dumas1 , F. Comeau1 , J. Fung2 , A. Lamontagne2 1 Quebec City, PQ, 2 Montreal, PQ, Canada Background and Aims: This study reports the development and application of a VR-based gait training program to promote the acquisition of anticipatory (planning) control in persons with chronic stroke. Methods: In a controlled study, VR subjects (n = 5) walked, while using a sliding handrail and a safety harness, on a self-paced treadmill mounted on a 6-degree-of-freedom motion platform in virtual environments (VEs) for 9 training sessions over 3 weeks. Platform movements were computer controlled to mimic changes in terrain encountered in 5 VEs (Street Crossing, Corridor Walking, Park Stroll, Train Station and Beach Walking) as persons walked with increasing difficulty (4 levels) related to time, terrain changes, obstacle avoidance and distance. Control subjects (n = 5) trained on the same treadmill while viewing still pictures. Simultaneous records were made of the terrain perturbations, hip and trunk movements (Polhemus system), gait speed and forces on the handrail. Results: In the VR-training group, comparison of body kinematics between early and late training sessions show that, with practice, a synchronization pattern of the hip movement emerges in anticipation to the terrain change and that this synchronization is often accompanied by changes in stride length, gait speed, and use of the handrail. Such changes were not observed in the control group that reacted to surface perturbations without benefit of the VEs. Conclusions: These results suggest that the VEs provide cognitive stimuli that can enhance and entrain postural orientation during walking in anticipation to environmental changes. This work was supported by the Canadian Stroke Network. P2.090 Gait after stroke benefits from acoustic pacing: an inquiry in possible underlying principles Roerdink° ,
C.J.C. Lamoth, J. van Kordelaar, G. Kwakkel, P.J. Beek M. Amsterdam, The Netherlands Background and Aims: Empirical evidence indicates that Parkinson’s and stroke patients’ gait benefits from acoustic pacing. However, the underlying process or principle is largely unknown. Detailed examination of auditory–motor synchronization of stroke patients led Roerdink et al. (2007) to conclude that acoustic stimuli for the non-paretic leg act as informational anchors upon which non-paretic footfalls are coordinated (i.e., perceptual–motor anchoring). The aim of the present study was to gain further insight into the perceptual–motor control of paced walking. Methods: Twelve stroke patients walked on a treadmill (comfortable walking velocity) under different configurations of acoustic pacing: (1) no pacing, (2) bilateral pacing (tones for both footfalls), (3) paretic pacing (tones for paretic footfalls only), and (4) non-paretic pacing. In a second experiment, acoustic rhythms were briefly perturbed; patients were instructed to adjust their gait to the metronome. Results: Nine patients were able to synchronize their gait with the metronome in all configurations. Gait symmetry and gait fluency improved with acoustic pacing compared to no pacing, whereas these beneficial effects were largely independent of pacing condition. The time to recover from perturbations increased from bilateral via non-paretic to paretic pacing.
Background and Aims: Ambulatory Gait Monitors (AGM) can be used to measure the frequency and quality of gait in patients’ own environment. The objective of this study was to investigate the feasibility and validity of an AGM (Dynaport Minimod) for patients with Parkinson’s disease (PD). We compared gait parameters obtained with the AGM with parameters obtained with a pressure-sensitive walkway (GAITRite® ). Methods: Thirty-two PD patients walked on the GAITRite® (criterion method) while wearing the AGM. Walking velocity (m/s), step length (cm), step time (s) and cadence were analyzed. Limits of agreement between gait parameters collected using both methods were calculated. Results: The results are presented in table 1. Table 1. Association between GAITRite and AGM Parameter
Correlation Difference, mean (SD) 95% limits of agreement
Velocity (cm/s) Step length (cm) Step time (s) Cadence (steps/m)
0.98 0.99 0.94 0.95
−5.5 (5.27) −2.01 (1.62) 0.01 (0.03) 0.28 (3.66)
−16.28 – 4.38 −5.19 – 1.17 −0.05 – 0.07 −6.9 – 7.45
Conclusions: Ambulatory gait monitoring is a promising tool to measure the quantity and quality of gait in the patients’ own home environment.
P2.092 Role of body weight supported treadmill training in retraining gait after stroke: randomized controlled study A. Srivastava° , A. Gupta, A.B. Taly, T. Murali, K. Sendhil Bangalore, Karnataka, India Background and Aim: Restoration of gait is major goal of stroke rehabilitation. Hypothesis: Stroke subjects trained by bodyweight supported treadmill training would show greater improvement in gait than those trained by conventional physiotherapy. Methods: Prospective study involved hemiplegics (n = 24) with inclusion criteria: first episode of supra-tentorial stroke of more than six months duration and ability to walk within functional ambulation category II−IV. Subjects were divided into two groups by random sampling after written informed consent and ethics committee approval. Group I – gait training by conventional physiotherapy, Group II – treadmill training with/without body weight support (20 min/day, 5 days/week for 4 weeks). Outcome measures were over-ground walking distance, speed and endurance. Data was collected before and after completion of training and at three months follow up and analyzed using Paired t-test for improvement within and Independent t-test for comparison between the groups. Results: Among group II, statistically significant improvement (p < 0.05) was noted for all three parameters after completion of training which was sustained at follow up, whereas, among group I, statistically significant improvement (p < 0.05) was noted for walking speed and endurance which was not sustained at follow up. While comparing between the groups,
